Community care plans could lead to a new generation of NHS organisations

Plans underway for community services look set to lead to a new generation of NHS organisations.

In the North West, strategic health authority chief executive Mike Farrar is looking at setting up two or three community foundation trusts, which together could provide some specialist community services to the whole region.

There is quite a head of steam of people thinking this is being done in a strange way

They would have roughly the income of medium sized district general hospitals and, because of their size, encourage challenge from the independent sector. They would allow community providers to join each other, acutes, local authorities or primary care organisations as required.

Meanwhile, acute and mental health foundation trusts have begun setting out their aspiration to take over community services - including moves into providing GP services.

University College London Hospitals Foundation Trust chief executive Sir Robert Naylor said GPs also needed to be integrated into large providers. He said: “Until we have that we will continue to have patients accessing acute services inappropriately.”

Rotherham Foundation Trust chief executive Brian James is speaking to several PCTs, including from areas outside of his own patch, about taking over their community services in what he calls a “chain” arrangement.

The moves come as primary care organisations have escalated their concerns over the short timetable given to come up with and implement plans for restructuring PCT providers, and the Department of Health’s apparent steer towards vertical integration.

Newcastle upon Tyne Hospitals Foundation Trust’s governors have published a prospectus - “Our Vision For Shared Care” - on why it is a “matter of distinct public interest” that they run community and primary services. The offer has not so far been embraced by commissioners, though the trust has won contracts to run primary care centres, and been approached by GPs who want to work with it.

Chief executive Sir Len Fenwick said: “It has made us realise we can bring a lot more to the quality and value for money equations.”

The PCT Network, NHS Alliance and National Association of Primary Care have all told HSJ they have been in close dialogue with the DH over the issue since the guidance was published at the beginning of this month.

PCT Network director David Stout said feelings were “running high” at the majority of PCTs.

He said: “It’s the hottest topic in primary care right now. “There is quite a head of steam of people thinking this is being done in a strange way,” he said.

In a letter to HSJ this week, Mr Stout adds: “Where PCTs have developed well thought through plans which do not involve vertical integration, it makes little sense for these to be dropped and replaced with hastily developed alternatives.”

The provider arm of NHS Buckinghamshire is set to vertically integrate with Buckinghamshire Hospitals Trust from 1 April, following a long term plan to transfer it to an acute or mental health provider.